In Syria, Doctors Beware

LONDON — There is something deeply unpalatable about doctors being attacked, detained or killed for doing their job. Yet, as an open letter published in The Lancet by 55 prominent international doctors highlights, the “deliberate and systematic” targeting of medical personnel and hospitals is a fact of life in Syria today.

Dr. Rola Hallam and I have returned from northern Syria after working with the charity Hand in Hand for Syria in one of the most challenging medical environments we have ever seen.

More than half of Syria’s hospitals have been destroyed or badly damaged in the conflict. According to the Violations Documentation Center, 469 health workers are imprisoned, and the Council on Foreign Relations estimates that 15,000 doctors have been forced to flee abroad. Of the 5,000 physicians in Aleppo Province before the conflict started, only 36 remain.

Doctors have been targeted without respect for their professional neutrality. Dr. Omar Arnous, 33, was arrested in Damascus on Oct. 6 last year with his wife and two-year-old son after he ignored warnings from government forces to stop treating the war-wounded. His family was released after 11 days, but he is still in detention. His exact whereabouts are unknown.

Taiba camp, with 1,000 tents, has no formal medical facility. A lone nurse is trying to provide some semblance of health care. She was desperate to show us examples of confirmed cases of typhoid and brucellosis, a highly contagious disease caught from consuming unsterilized milk or meat.

The nearest antibiotics were an hour away. Medicines are in pitifully short supply throughout the country since several of Syria’s pharmaceutical manufacturing plants were hit by shells.

Resupply and support from international nongovernmental organizataions is difficult. Aid cannot be delivered in the simplest way — over the border. All pledged aid has to go through Damascus and be distributed from there by the Syrian government.

A repeated tactic, breathtaking in its cruelty, is the targeting of health care workers as they enter an area after an airstrike. A number of health workers have been killed or wounded in this way.

Removing chemical weapons from Syria is now central to international policy debate, but thoughts must turn to other types of lethal weapons used by the Syrian regime in civilian urban areas. This month, Dr. Hallam and I found ourselves in a school that had been hit by a napalm-like bomb. Thirty students were severely burned and three of them died later from their wounds.

An error has occurred. Please try again later.

You are already subscribed to this email.

Dr. Hallam, who is British of Syrian descent, said: “The whole world has failed our nation, and it is innocent civilians who are paying the price.”

Medical workers are stretched to the limit. Four staff members collapsed and needed attention themselves. Overworked, exhausted and with little outside support, how much longer can they continue? Health care workers and the wounded are protected under international humanitarian law, but in Syria they are deemed high-value targets. Hospital locations have to remain secret and field hospitals move from place to place to avoid being compromised.

The danger is so well understood that a family living next door to a hospital, to which I had transferred a gunshot patient, could be seen digging a shelter. Last month the hospital was hit by an airstrike, killing six people, one of them a doctor. I do not know if the family completed their shelter in time.

A U.N. team of investigators, led by Paulo Pinheiro, a Brazilian legal expert, describes intentional attacks against hospitals as a war crime. At the moment, that makes little difference to those who are in the direct line of fire.

The international community must condemn attacks against hospitals and health workers in the strongest terms. Beyond that, it must immediately offer support and protection to those providing health care to innocent civilians.

Saleyha Ahsan is an emergency medicine doctor working in London and a former British Army officer. This article also appears in the latest issue of The World Today, published by Chatham House.

A version of this op-ed appears in print on October 4, 2013, in The International Herald Tribune. Today's Paper|Subscribe